Mental Health Services in General Health Care A Conference Report, Volume I (1979) / Chapter Skim
Currently Skimming:
III. Keynote Presentations
III. Keynote Presentations
Pages 15-40
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 15... ...
But it has been a kind of stark and brutal fact, overwhelmingly apparent to anyone reasonably familiar with the subject, that some gravely ill persons were receiving treatment of essentially unknown characteristics and there was reason to be concerned about finding ways to improve the care that they get within the general health system. We have been aware, too, that beyond the overtly mentally ill, a much larger number - though we could not specifically say what the number is -- have problems in living manifested by truly burdensome emotional distress; these individuals are thought to be almost entirely looked after in the general health care system.
|
From page 16... ...
Surely, it must be a focus of excellent nationwide collaboration between mental health and general health professionals. Right?
|
From page 17... ...
On the governmental side, the President's Commission on Mental Health, under Mrs. Carter's leadership, gave the coordination of mental health and primary health care services a distinct emphasis.
|
From page 18... ...
Wilson. "Neighborhood Health Centers as Providers of Coordinated Mental Health Care," invited paper of the Institute of Medicine Advisory Committee on Mental Health submitted to the President's Commission on Mental Health, February 13, 1978.
|
From page 19... ...
In the course of conducting that study, the internists, the pediatricians, and family practitioners who were consulted in our advisory panel, and the Steering Committee, emphasized not only insomnia, but other mental health problems, as a major part of medical practice. This provided a practical reaffirmation that a major portion of medical responsibility in virtually every field has to do with mental health problems.
|
From page 20... ...
20 Finally, I want to welcome our guests from abroad. There is a great deal we can learn from their experience.
|
From page 21... ...
In this context, complaints regarding the disappearance of the old style family doctor seem tied particularly to decline of the personal relationship and psychological sensitivity he supposedly offered. The re-energized family practice movement has emphasized its needs for a major mental health component, both in its training and its clinical work.
|
From page 22... ...
Regier, and others have noted that the recent National Ambulatory Medical Care Survey showed that a diagnosis of mental disorder as a primary or otherwise existing condition was made in about 2 percent of all visits to office-based pediatricians in the United States (Goldberg~et al, 1979~. On the other hand, in their study of outpatient pediatric service use conducted in Monroe County, New York, the authors found that two-anda-half times that rate, or 5 percent, of the children visiting the sample of pediatricians in that locale had mental health problems.
|
From page 23... ...
Furthermore, we know now that people who come to primary care and general health care physicians with mental problems usually have a higher rate of organic illness and utilize health services more frequently than do people with other than mental health disorders (Eastwood and Trevelyan, 1972~. These facts suggest that more effective treatment of this population would have important ramifications, both for health care utilization and incidence of organic difficulties.
|
From page 24... ...
Inevitably, questions of turf arise, with some people in the mental health sector feeling threatened by the notion that people in the general health care and primary health care sectors may appropriate some of their roles. Also, there are questions of the appropriate role in mental health care of primary care physicians, given their training, orientation and temperament.
|
From page 25... ...
The need for such interaction at the service level, too, has been recognized by the Bureau of Community Health Services of the Health Services Administration, as well as by the Division of Mental Health Service Programs at NIMH e The two have collaborated on the development of projects in which mental health practitioners are brought right into general health care settings for active interaction, consultation, and mutual education. The interaction of the mental health and health system is important.
|
From page 26... ...
Perhaps the primary care physician or general health care practitioner is wondering, if he broadens his field of attention to include behavioral and psychosocial issues, will his mother and his medical society still think he is a real doctor? Is the solution one of the general health sector handling both health and mental health care?
|
From page 27... ...
Impact of alcohol, drug abuse, and mental health treatment on medical care utilization: a review of the literature. Unpublished DHEW manuscript, February 1979.
|
From page 29... ...
Dr. Cunningham's personal experience as a primary care physician in a community health setting suggests that the new BCHS funding essentially represents formal Federal recognition and support of an ongoing trend in individual communities, where mental health services and primary care services increasingly have been integrated through less formally defined linkages such as staff sharing.
|
From page 31... ...
Psychiatrists and mental health professionals in general tend to shift unknowingly -- I will not say unconsciously -- fram talking about mental health as, narrowly, mental illness to mental health as a field that includes alcoholism, drug abuse, developmental disabilities, retardation and other concerns that at various times have not been at the center of psychiatric thinking. This is a matter of particular concern to me in my current role because of the sensitivity
|
From page 32... ...
Now, we can, in effect, do a comparative analysis of experiments of administrative nature by comparing the consequences of our dissolution of general practice, an inadvertent experiment of administration, perhaps, with the British experience, where they not only did not allow that to happen, but purposely strengthened the general practice network as their major mode of contact with patients with mental illness. I think it is significant that the organizers of this conference have invited Michael Shepherd, and that David Goldberg is here in the United States on sabbatical from England, continuing this work.
|
From page 33... ...
It is not to be presumed from this that all the remaining 85 percent are without symptoms. One of the important things that also has emerged from the epidemiologic research is that in addition to those individuals with such definable disorders as neurotic depression or clear-cut alcoholism, who constitute this 15 percent, there are significant additional numbers, perhaps as many, with transient symptoms, perhaps stress reactions, periods of insomnia, weight change, and backaches, and the people experiencing these use the health care system to a great extent.
|
From page 34... ...
Adults (18-65) Depression and Affective Disorders Anxiety, Phobia, and Other Neuroses Alcoholism and Alcohol Problems Drug Dependence Schizophrenia Aged (over 65)
|
From page 35... ...
Although this conference has focused in its planning on the mental health component, I would hope that at times you would pay attention to the existence of comparable but not identical problems in the recognition and treatment of persons suffering from various alcoholism and drug abuse disorders. I made mention earlier that one of the advances in policy has come from the field of health services research, and particularly from the conceptualization of primary, secondary and tertiary care.
|
From page 36... ...
Figure 2 FOUR LEVELS OF HEALTH ADM HEALTH CARE Level of General Alcohol Abuse Drug Abuse Mental Heal th Intensity Facilities Facilities Facilities Facilities of Care and Services and Services and Services and Services Primary Neighborhood Primary Care Primary Care Primary Care Health Centers Practitioners Practitioners Practitioners Secondary Community Alcohol Treat- Drug Treat- QIHCs Hospital ment Centers ment Centers Tertiary Specialized Alcohol Treat- Residential Treat Elospitals ment Hospitals ment Centers for Children and Adolescents Long-term Ilome Care State Hospitals Community Support Services Programs; State Nursing Homes Hospitals
|
From page 37... ...
This so-called deinstitutionalization policy, while perhaps most controversial in the case of mental illness, has corresponding issues for arthritis, alcoholism, and cardiovascular disease. The policy within the primary care setting is to facilitate-with government support and legal encouragement -- the development of organized modes of delivery of primary care, among them the Federally supported network of urban health centers, migrant programs, and rural health centers, and the use of Federal monies to create a new form for delivery of primary care through organized, if not operated, Federally supported programs.
|
From page 38... ...
A survey of CNS psychoactive drug prescriptions indicates a downturn in the number of prescriptions for hypnotics and sedatives in the past five years, and especially rapid decrease in the number of prescriptions for stimulants in the 1970s. Figure 3 110 100 90L 80L 70: ant 50 40 30 10 _ O _ Antianxiety Agents / \ ~ Hypnotics Sedatives _ —____ Antidepressants `_ ~ me, ._ ~~ Antipsychotics ~ 'a__ Stimulants 1' ~ 1 1 1 1 1 1 1 1 1 1 1964 1966 1968 1970 1972 1974 1976 YEAR
|
From page 39... ...
Psychiatrists account for only about 15 percent of all the psychoactive drug prescriptions written. All the others are written by general health care physicians, particularly the primary health care physicians.
|
From page 40... ...
nrim~rv care nhvsicians per Here, The issues are what sectors of the health care system are most appropriate for dealing with these problems; what forms of technology of Err-—rid c, available to us are, in fact, efficacious, whether they be drug or psychotherapeutic; and which types of personnel are most useful currently or in some hypothetical future. And, assuming there can be some agreement as to the goals, what is the role of the Federal government through reimbursement programs like health insurance, through categorical programs like funding of mental health care centers or linkage grants, or through training efforts, to move the system to a more rational integrated basis, instead of the avowedly fragmented basis we have now.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.